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HELPING THOSE WITH CHRONIC HEART FAILURE

Posted on Mar 12, 2018 1:00pm PDT

Improving quality of life for people with chronic heart failure

UNIVERSITY OF COLORADO ANSCHUTZ MEDICAL CAMPUS

Patients with chronic heart failure face related problems, such as depression
and fatigue, that could be relieved by an expanded model of care, according
to a recently published study led by a researcher from the University
of Colorado School of Medicine.

The study, "Effect of a Collaborative Care Intervention vs Usual Care
on Health Status of Patients With Chronic Heart Failure: The CASA Randomized
Clinical Trial," published in the current issue of the journal
JAMA Internal Medicine, found benefit to some aspects of patients' quality of life when conventional
cardiac therapy is supplemented with a nurse and a social worker who collaborate
with a team to address patients' symptom and psychosocial needs.

"Many of the 5.8 million Americans with heart failure live with bothersome
symptoms, reduced function and poor quality of life" said David B.
Bekelman, MD, MPH, the study primary author. "Improving their care
is important because many people with heart failure live with these challenges
for years."

Bekelman, an associate professor of medicine who practices at the Eastern
Colorado Health Care System for the U.S. Department of Veterans Affairs,
and his colleagues evaluated 314 patients, with half of them enrolled
in a program that addressed those quality of life concerns.

The Collaborative Care to Alleviate Symptoms and Adjust to Illness intervention,
also called CASA, offered 157 patients a nurse and social worker who collaborated
with a primary care provider, cardiologist, and palliative care physician
to address the patients' needs. The CASA trial is the first clinical
trial of such a collaborative intervention in heart failure and it included
patients receiving care from VA, academic and safety-net health systems
in Colorado between August 2012 and April 2016. Patients enrolled in the
study were evaluated for a one-year period. The typical CASA intervention
was three to four months.

The CASA intervention significantly improved patients' depression and
fatigue but did not result in significant changes in heart failure-specific
health status, pain, shortness of breath, or number of hospitalizations.
The number who died during the study was similar - 10 of the patients
in the CASA intervention died, while 13 of those receiving the typical
standard of care died.

The improvements in depression and fatigue are important results because
they are both common, burdensome, and difficult to treat in heart failure,
Bekelman said. Very few other studies have found treatments for these
symptoms in patients with heart failure. Furthermore, the improvement
in depression lasted the whole duration of the patient's 12-month
study period, months after the CASA intervention ended.

Bekelman discussed several next steps in the research, including studying
the intervention in a higher-risk or more ill population, and using health
technology, such as videoconference, to extend the reach of the CASA intervention.

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In addition to Bekelman, authors of the study included faculty from the
CU School of Medicine (Larry A. Allen, MD, MHS; Connor F. McBryde, MD;
Brack Hattler, MD; and Edward P. Havranek, MD), the Colorado School of
Public Health (Diane L. Fairclough, DrPH), the University of Iowa Carver
College of Medicine (Carolyn Turvey, PhD) and the CU College of Nursing
(Paula M. Meek, RN, PhD).

The study was supported by funding from the National Institute of Nursing
Research, the Colorado Clinical and Translational Sciences Institute,
and the VA's Health Services Research and Development Service.

About the University of Colorado School of Medicine

Faculty at the University of Colorado School of Medicine work to advance
science and improve care. These faculty members include physicians, educators
and scientists at University of Colorado Health, Children's Hospital
Colorado, Denver Health, National Jewish Health, and the Denver Veterans
Affairs Medical Center. The school is located on the Anschutz Medical
Campus, one of four campuses in the University of Colorado system. To
learn more about the medical school's care, education, research and
community engagement, visit its web site.